Understanding the factors associated with fracture is one of the main research objective of the osteoporosis epidemiology field. Tools such as FRAX have overall improved the ability of clinicians and researchers to identify individuals at high risk of fragility fractures. However, the performance of these tools in specific subpopulations needs further examination. We highlight recent studies that have shown under- or overestimation of fractures using FRAX in subpopulations, as well as recently proposed modifications to this important algorithm. We also discuss recent evaluations of secular trends in fracture incidence. © Springer Science+Business Media, LLC 2012.